Healthcare Provider Details

I. General information

NPI: 1134651458
Provider Name (Legal Business Name): STEPHANIE RYCHLEC MAT, ATC, OTC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 BRIARGATE PKWY STE 145
COLORADO SPRINGS CO
80920-7836
US

IV. Provider business mailing address

6450 BLACK RIDGE VW APT 205
COLORADO SPRINGS CO
80924-4455
US

V. Phone/Fax

Practice location:
  • Phone: 719-622-4550
  • Fax:
Mailing address:
  • Phone: 303-906-8069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT5911
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT.0001808
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: